Discussing Payment: How to be Both Polite and Effective

  1. You should always assume that a patient/client can afford the recommended treatment when discussing payment with him. Don’t be shy, embarrassed or apologetic about the cost of your services. This can give the appearance that the treatment isn’t worth the fee being charged.

    When making financial arrangements, your goal should be to collect the entire fee at the time of service via direct payment and/or verified insurance reimbursement. You should have a well-defined financial policy for patients to read and agree to with regard to payment of service.

    It is important that the accounts manager does not give the patient/client the opportunity to say “no”. Never say, “Would you like to take care of that today?” Instead, give her options that are compatible with office policy. For example: “Mrs. Smith, the fee for today is $50. Will you be paying with cash, check or credit card?”

    With such an approach, “no” is simply not an option. Remember, if you make clear financial arrangements in the first place, you won’t have any trouble collecting the amount due.

    Suppose there was a misunderstanding and the patient/client tells you she can’t afford to pay the entire balance at the conclusion of the visit. Your reply might be, “Could you tell me how much you are able to pay at this time?”

    The idea here is to get the largest payment possible. Now you need to secure the balance: “Mrs. Smith, that will leave a balance due of $560. We need to work out an agreement on how that will be taken care of.” When she agrees to a definite date for the payment of the balance, put the information on a financial agreement form and have her sign it.

    If it becomes necessary to offer a monthly payment plan to a patient/client, adhere to the payment schedule as governed by office policy. Do not stray from the established policies.


    Though not a common occurrence, you might encounter someone who cannot afford adequate monthly payments, but who does want care. You could consider implementing a “layaway” plan, wherein the client/patient would agree to send in a small amount each month that you would credit to his account; and when he has accumulated enough in his account to cover the desired treatment, you would contact him to schedule an appointment. This system would certainly require approval from the doctor/owner prior to implementation. It isn’t ideal, as the patient could be putting off necessary treatment, causing his condition to worsen in the interim.


    When a patient/client has health insurance, address payment in this manner:

    “Mrs. Smith, your insurance will cover approximately 80% of this bill. Your portion will be approximately $120 (20% of the total). Would you like to pay cash or write a check today?”

    If she replies, “I’ll just wait until the insurance company pays you and then I will pay you the balance due,” you might respond:

    “Well, Mrs. Smith, our office policy is that you are responsible to pay at the time of service the portion your insurance won’t cover. I know from having worked with your insurance carrier in the past that they will cover about 80% of the fee for this treatment. Your portion will amount to $120. If it turns out to be less, we will certainly refund any overpayment.”

    If a client/patient ever becomes upset about the insurance issue or you feel that he is unhappy, it would be advisable to explain to him the way that insurance companies operate, including how they can delay payments, challenge the treatment diagnosis, etc. You can also remind him that his insurance is an agreement between his insurance company (or employer) and him, not with your office. Most likely, once you have clarified that with him, and he truly understands, you will not have to deal with the matter again. The best time to discuss the issue of insurance coverage is when the new patient/client initially arrives. Written financial policies that a patient reads, and to which he agrees ahead of time, will alleviate many such problems.

    You MUST let your clients/patients know how much their treatment is going to cost. In doing so, you should feel comfortable and be able to speak with conviction. If it is at all uncomfortable for you, have another staff member practice with you until you do feel comfortable.

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